ELBOW Flashcards
what are the movement dx for the elbow
tissue impairment
nerve entrapment
wrist ext with pronation wrist flexion with pronation hypomobility elbow flexion syndrome valgus syndrome elbow extension syndrome
H E E F F V
acute tissue injury in the inflammed state would be what mvmt dx
tissue impairment
explain wrist extension with pronation syndrome
the wrist extensors and pronators are overused.
there is LATERAL elbow px.
px with gripping
associated with scap abd
dx related to wrist extension/prontation syndrome
lateral epicondylitis
LCL sprain
extensor sprain
what nerve can be stressed with repetitive elbow flexion
ulnar
wrist flexion with pronation syndrome, px is usually where
medial elbow
explain wrist flexion with pronation syndrome
overuse of wrist flexors and pronators
medial elbow px
pathologies assct. with wrist flexion and pronation syndrome
medial epicondylitis
flexor strains
medial epicondylitis is aka
golfer’s elbow
lateral epicondylitis is aka
tennis elbow
fractures, dislocation, recent surgery (but not in acute inflammatory stage) would be what mvmt sx dx
elbow hypomobility
with hypomobility, ____ is lost the most
elbow flexion
explain elbow flexion syndrome
repetitive elbow flexion causes numbness or tingling in the hand
there is usually sensory loss before motor
can result in CLAW hand
what muscle is often tight with elbow flexion syndrome
FCU
what pathologies are related to elbow flexion syndrome
cubital tunnel syndrome
ulnar nerve irritation
valgus stress syndrome usually causes a tight
pronator teres
pathologies assct. with valgus syndrome
MCL sprain ol. bursitis could be med. epicondylitis (if valgus stress caused) triceps tendon valgus extension overload syndrome
explain elbow extension syndrome
there is post elbow px at end range ext
there can be elbow hyper or hypo ext
what dx are assct with elbow ext syndrome
ol. bursitis
triceps
post fxs or dislocations
if issue is throbbing px, you have to look into possible
nerve entrapment
wrist flexors originate at the
medial epicondyle
brachioradialis origin
humerus
brachioradialis axn
flex
pronates
supinates
pronator teres runs from ___ to ___
ulna to radius
brachioradialis N
radial
most wrist flexors are ___ N
median (except FCU is ulnar)
active supination causing sx to the elbow (lat), why would this make sense
one of the origins is lateral epicondyle (if person has lateral epicondylitis, active supination can cause sx)
also, radial N entrapment can flare with supination
4 muscles that may show weakness dt radial N entrapment (the kind that has motor sx)
extensor digatorum
Abductor PL
and EPL/Brevis
one very simple thing to tx nerve entrapment
if there is a specific muscle that is entrapping, stretch it to take off compression
simple concept to tx strain
stretch the side (or muscle) that is strained
strengthen the antagonist muscle
N to the pronators
median
N to supinator
radial
N to extensors of wrist
radial
wrist extensors origin is the
lateral epicondyle
if pt lacks supination, what may be too tight
antagonists (pronators)
during ext, ulna moves ____
Ulna moves laterally during extension, due to articular groove and distal medial aspect
normal carrying angle men
women
men 5-15
women 15-20
this resists valgus force
MCL or UCL
the two bands of the MCL and what they resist
ant - flex and ext
post - flexion only
resting position HU joint
70 degrees of flexion, with 10 degrees of supination
closed packed HU joint
full ext and supination
capsular pattern HU joint
flexion is more limited
the ___ Ligg provides a sling around the radial head
annular
HR joint resting position
Full extension and forearm supination
HR joint closed packed
90 degrees of elbow flexion and 5 degrees of supination
HR joint capsular pattern
Flexion > extension, equal limitation of pronation and supination is observed
proximal RU joint open pack
70 degrees of flexion and 35 degrees of forearm supination
proximal RU joint capsular
pronation = supination, minimal to no loss of motion, with pain at the end ranges of pronation and supination
these structures provide stability to distal RU joint
Interosseus membrane
Articular disc
Anterior radioulnar ligament
Posterior radioulnar ligament
annular lig and interossei provide stability to the ___RU joint
proximal
Ulnar abduction occurs with ___ and ___
pronation and ext
ulnar adduction occurs with ___ and __
sup and flexion
arc of motion is ___ to ___
30 - 130
ulnar nerve goes through the ___
cubital tunnel
___ and ___ cause stress on the ulnar nerve
flexion and valgus
ulnar nerve sensation loss would be felt where
pinky and wring finger (palmar and dorsal sides)
where is median nerve sensation loss
palmar side of thumb, then digit 2 and 3
median nerve trapped at forearm is ___
median nerve trapped at wrist is___
forearm - pronator teres syndrome
wrist - carpal tunnel
radial N sensory loss is where
lateral, post forearm
backside of hand and forearm
carrying angle over 25 is considered
cubital valgus
post interosseus N issues are associated with more motor or sensory
motor
post interosseus N issues will manifest how
will have probs with thumb ext or MCP ext. (thumb abd or digit extensors)
epicondylitis vs algia
itis infers that there is current inflammation, algia is preffered over itis
which is more common lateral or medial epicondylitis
lateral
main muscle involved in lateral epicondylitis
ED
repetitive wrist extension and/or grasping that causes
Dull ache at rest, sharp pain at lateral epicondyle with lifting
lat epicondylitis
deep friction massage is a good tx for
epicondylitis
2 main muscles for medial epi
FCR and pronator teres
cubital tunnel syndrome, there are motor changes with
adductor pollicis
epiphisitis of medial epicondyle
LLE (little leaguers elbow)
LLE (little leaguers elbow) sx
Loss of full extension of elbow
Pain with resisted flexion
why is there px with resisted flexion with LLE
bc the flexors originate at medial epcicondyle
Affects growth, ossification centers in children
Begins as degeneration or necrosis of capitellum (lateral humerus) and followed by regeneration, recalcification (similar to legg calve perth of hip)
panners disease
if you suspect panners, never do a ____ force
valgus
Loss of blood supply as a result of traumatic injury like compression forces. (lateral compressive force)
Has popping and clicking
osteochondritis dissecans
biceps rupture is usually (prox or distal)
distal (from quick forceful contraction)
dorsal side of hand is mostly ___ N
radial (not including distal fingers)
what is cubital tunnel syndrome
ulnar nerve compression distal to the medial epicondyle
cubital tunnel syndrome can sometimes present with
claw hand
repetitive elbow ____ causes cubital tunnel
flexion
weak pinch grasp is indicative of
cubital tunnel
parathesia in thumb, index and middle finger
median N
radial tunnel syndrome vs radial N compression by supinator
radial tunnel syndrome is at the elbow (compressed at radial head)
if it is compressed by supinator it is called post Int. N compression
Post interosseus - motor sx
radial tunnel syndrome - sensory sx
radial tunnel syndrome presents with sensory sx where
back of forearm
what is typically torn in a disclocated elbow (radial head)
annular lig
tommy john surgery is for
MCL
ext valgus overload syndrome involves what structures
compression of olecranon on the humerus
where is px with ext valgus overload syndrome
post elbow (AROM ext PROM pronation)
most common elbow injury in adults
radial head fx
most common elbow fx in children
supracondylar
pronators are ___ N
median
numbness and tingling at 4th and 5th digit think
cubital tunnel syndrome
Pain in the volar (palmar) aspect of forearm into the index and middle finger; parasthesia in thumb, index finger, middle finger aggravated with activity
pronator teres syndrome
tenderness distal to lateral epicondyle and motor sx to the extensors of thumb or digits
post interosseus N issues
medial glide of HU joint helps with
flexion and add
lateral glide of HU joint helps with
ext abd
medial gap of HU joint helps with
flex
ext
pron
lateral gap of HU joint helps with
flex
ext
pron
HR joint dorsal/post glide helps with
ext (these you are on the radial head)
HR volar/ant glide helps with
flexion (you are on the radial head)
Proximal RU joint post glide helps with
pronation
proximal RU joint ant glide helps with
supination
Distal Radioulnar joint post glide helps with
supination (and flex/ext of wrist)
Distal RU joint ant glide helps with
pronation (and flexion/ext of wrist)
normal elbow flexion is
140
normal elbow ext is
0
normal supination
80
normal pronation
80
at the end of shoulder elevation, explain clavicle
30-40 degrees of posterior clavicular axial rotation and 30-40 degrees of calvicular elevation
2 forms of radial nerve entrapment
radial tunnel - no motor loss (px at lat epi and rad. head)
post int. - px is distal, there are motor sx to finger/thumb extensors and add PL
open packed pos for prox RU
70 flexion 35 sup
open packed for distal RU
10 sup
HR distraction helps with
pro and ext
mvmt dx lateral epicondylitis or extensors issue
wrist ext with pronation
ulnar nerve issues at elbow is what mvmt dx
elbow flexion syndrome
olecranon bursitis is what mvmt dx
elbow ext syndrome (which is really px that is caused by end range elbow ext)
so cubital tunnel presents with both sensory and ___
motor
sensory to ulnar N distritubtion
motor to adductor pollicis
list the 7 hand muscles innervated by ulnar nerve
Adductor pollicus FCU ABD DM Flexor DM OPP DM 3 and 4 lumbricals interossei
Pain over lateral elbow during gripping activities
lat epicondylitis or radial N
numbness tingling to ulnar nerve distal to ulna itself think
cubital tunnel syndrome
post interosseius N is a branch of
radial - does all extensors and snuff box
both gap mobs help with
FEP
list the nerve pathologies (all)
radial - radial tunnel syndrome (at radial head) sensory sx
- post interosseius issues (at supinator) motor sx to
forearm extensors
Median - carpal tunnel syndrome at wrist
- pronator teres syndrome at forearm
Ulnar - cubital tunnel syndrome at elbow
- tunnel of guyon at hand
for HR glides, you MUST be (their position)
fully extended and supinated
for HR post glide they are
full palm up/supine
for HR ant glide they are
thumb up, elbow straight
what does a lateral HU glide facilitate
ext and abd
panners is on what side
lateral elbow
